This study introduced a novel point “O” puncture approach for percutaneous kyphoplasty (PKP) in patients with L4 or L5 osteoporotic vertebral compression fracture (OVCF) and evaluated its clinical and radiographic outcomes. Between September 2019 and December 2020, we compared the clinical and radiographic outcomes in 31 cases (36 vertebrae) using the “O” entry point PKP intervention (O-PKP) and 31 cases (37 vertebrae) using transverse the process-pedicle approach PKP intervention (T-PKP). No serious postoperative complications were observed in any of the participants. Only two T-PKP patients experienced intervertebral disc space leakage. Compared with the T-PKP patients, the O-PKP patients showed shorter operative time and fluoroscopy times (P < 0.05), comparable blood loss and cement volume (P > 0.05), improved VAS and ODI scores at the final follow-up (P < 0.05), better increases in the vertebral compression ratio (P < 0.05), comparable Cobb angle (P > 0.05), comparable anteroposterior bone cement distribution, enhanced bilateral bone cement distribution (P < 0.05), and larger sagittal and transverse angles (P < 0.05). Herein, O-PKP was indicated for patients with L4 or L5 OVCF. This puncture approach showed significant advantages over T-PKP not only in terms of pain relief, surgery and fluoroscopy times but also in the puncture angle, vertebral reconstruction, and symmetrical cement distribution.

[Objective] This study introduced a novel point “O” puncture approach for percutaneous kyphoplasty (PKP) in patients with L4 or L5 osteoporotic vertebral compression fracture (OVCF), and evaluated its clinical and radiographic outcomes.[Methods] Between September 2019 and December 2020, we compared the clinical and radiographic outcomes of 31 cases (36 vertebrae) of “O” entry point PKP intervention (O-PKP), and 31 cases (37 vertebrae) of transverse the process-pedicle approach PKP intervetion (T-PKP).[Results] All participants completed surgery without serious complications. Only 2 T-PKP patients experienced intervertebral disc space leakage. Compared to the T-PKP patients, the O-PKP patients exhibited less operation and fluoroscopy times (P<0.05), comparable blood loss (P>0.05), improved VAS and ODI scores at the final follow-up (P<0.05), more preferable increase in the vertebral compression ratio (P<0.05), comparable Cobb angle (P＞0.05), comparable anteroposterior bone cement distribution, enhanced bilateral bone cement distribution (P < 0.05), and larger sagittal and transverse angles (P<0.05). [Conclusion] Here, O-PKP was indicated for patients with L4 or L5 OVCF. This puncture approach exhibited significant advantages over the T-PKP not only in terms of pain relief, operation time, and fluoroscopy times, but also in the puncture angle, vertebral reconstruction and symmetric cement distribution.